ADDRESSING COMORBID CHRONIC PAIN AND EARLY COGNITIVE DECLINE IN OLDER ADULTS: THE ACTIVE BRAINS EFFICACY TRIAL

Abstract Chronic pain (CP) and early cognitive decline (ECD) are costly, highly prevalent, and challenging to treat among community-dwelling older adults. CP and ECD commonly co-occur, exacerbate each other, and can accelerate dementia. Our interdisciplinary team has developed Active Brains (AB), a virtual group mind-body walking program aided by Fitbit, to address this comorbidity. We are conducting a single-blinded, NIH stage 2 RCT to establish the efficacy of AB versus a time- and dose-matched education control (Health Enhancement Program; HEP) in 260 older adults with CP and ECD. In this symposium, we will describe the study design, recruitment numbers, and maximizing the inclusion of racial and ethnic minoritized older adults (38% benchmark). Participants are recruited through providers, social media, and community partnerships. Participants wear an ActiGraph to monitor steps and are randomized to 8 weeks of AB or HEP delivered via Zoom by an MGH psychologist. The AB group receives a Fitbit to reinforce activity goals. Primary (multimodal physical function) and secondary (cognitive and emotional function, pain) outcomes are collected at baseline, post-intervention, and 6 months. We have recruited 37 participants (4 cohorts). All 37 completed the baseline, 26 completed the post-test, and 9 are currently enrolled (total dropout = 5%). Session attendance (92.8%) and watch adherence (93.5%) have been excellent. The trial will establish efficacy, test mechanisms, and inform a future multi-site effectiveness-implementation trial. Consistent with the GSA 2023 theme, AB has the potential to catalyze non-pharmacological interventions for CP–ECD and empower older adults to maintain active and meaningful lives.

recruited 37 participants (4 cohorts).All 37 completed the baseline, 26 completed the post-test, and 9 are currently enrolled (total dropout = 5%).Session attendance (92.8%) and watch adherence (93.5%) have been excellent.The trial will establish efficacy, test mechanisms, and inform a future multi-site effectiveness-implementation trial.Consistent with the GSA 2023 theme, AB has the potential to catalyze nonpharmacological interventions for CP-ECD and empower older adults to maintain active and meaningful lives.

ADDRESSING THE CHRONIC PAIN EPIDEMIC AMONG OLDER ADULTS IN UNDERSERVED COMMUNITY HEALTH CENTERS
Ana-Maria Vranceanu 1 , Jonathan Greenberg 2 , Katherine McDermott 2 , Madison Ehmann 1 , Nadine Lecvy 1 , Julie Brewer 1 , and Christine Ritchie 1 , 1. Massachusetts General Hospital,Boston,Massachusetts,United States,2. Massachusetts General Hospital/Harvard Medical School,Boston,Massachusetts,United States Current nonpharmacological treatments are inadequate for addressing chronic pain among older adults from disadvantaged backgrounds.These treatments have been developed for affluent populations and are not implemented in underserved community health centers (CHCs) where most older adults with chronic pain seek care.We conducted 4 focus groups with 23 providers (e.g., primary care doctors, nurse practitioners, medical interpreters and support staff) and 4 focus groups with 15 English-and Spanish-speaking patients at a CHC.Our goals were to: 1) understand barriers and facilitators to sustained implementation of the GetActive+ mind-body activity program delivered by a nurse practitioner; 2) gather perceptions of program skills to facilitate cultural tailoring; and 3) gather information to support a future hybrid type 1 effectiveness implementation trial of GetActive+ versus usual care to improve pain outcomes.Qualitative analyses were conducted using a deductiveinductive approach and the Framework method.Questions were informed by Aaron's implementation model and the Socioecological model.Results revealed multiple barriers at the individual (e.g., pain misconceptions, perceived bias, stigma, shame, treatment expectations and loneliness, language barriers, food and financial insecurity), health clinic (e.g., provider burnout, understaffed clinic, budget cuts, multiple languages) and environmental levels (e.g., lack of technology, lack of reliable transportation to clinic, billing challenges).Clinic providers felt unprepared to support older adults with chronic pain.Both patients and providers endorsed the need for, and skills of GetActive+.Nuanced differences between patient-provider and English-Spanish patients as well as modifications to the program manual, protocol, and interventionist training will be discussed.
Hopkins University,Baltimore,Maryland,United States,3. University of Texas,Austin,Texas,United States,4. Massachusetts General Hospital,Boston,Massachusetts,United States Despite facing greater risks for poorer health, low-income White and BIPOC older adults underutilize mental health services even when they have indicated need.Increasing the repertoire for depression care that is community-based and uses paraprofessionals has potential to increase access and engagement.We are testing the effectiveness of a peer support intervention called Peer Enhanced Depression Care (PEERS) which is an 8-week community-based intervention that uses trained peer mentors to deliver emotional, appraisal and informational support in addition to encouraging self-care skills to depressed low-income white and BIPOC older adults.Enrolled participants are randomized to either the peer support intervention (PEERS) or to the social interaction control and followed for 12 months.The primary outcome is depression and secondary outcomes include engagement, mental health service use, and social, emotional, and physical functioning.Challenges related to the onset of the COVID-19 pandemic and social isolation required a shift from recruitment initially focused on the health care system to community-based organizations serving older adults.Required contactless recruitment strategies eg.flyers and newspaper ads, led to self-referral of community-dwelling older adults to the study.Challenges to participant enrollment included barriers related to communication, stigma related to help-seeking, distrust and unfamiliarity with research.Recruitment of peer mentors was facilitated by a robust infrastructure supporting the employment of the peer support workforce.Continued PM supervision after initial training, review of skills and evaluation of performance were important in maintaining quality and fidelity to the intervention.

A STAKEHOLDER-PARTNERED APPROACH TO INEQUITIES AFFECTING HOME HEALTH CARE WORKERS, OLDER ADULTS, AND CAREGIVERS
Olivia Okereke 1 , Vivian Anable Eme 2 , Keliane Totten 3 , Joseph Locascio 4 , Alison Simmons 5 , Nancy Carpenter 5 , and Anthony Weiner 6 , 1. Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts, United States, 2. Massachusetts General Hospital, Boston, Massachusetts, United States, 3. Pear Associates, LLC, Wellesley, Massachusetts, United States,4. Biostatistics,Massachusetts General Hospital,Boston,Massachusetts,United States,5. Center for Community Health Education Research and Service (CCHERS),Boston,Massachusetts,United States,6. Geriatric Psychiatry,Massachusetts General Hospital,Boston,Massachusetts,United States Home health aides (HHAs) provide on-site support for homebound older adults with cognitive impairments, while lessening strain on familial caregivers.However, HHAs face structural challenges in work-related transportation.Massachusetts General Hospital (MGH) researchers partnered with community and corporate stakeholders to inform a study evaluating whether on-demand transportation for HHAs via Uber rides will: 1) Improve metrics among HHAs (total visits, total unique patients, hours/week and days/ week worked, missed visit/no-show rates, work satisfaction); 2) Increase racial, ethnic, socioeconomic and geographic diversity of older adults with cognitive impairments receiving homecare.Community partner CCHERS (Center for Community Health Education Research Services) helps residents of public/publicly-assisted housing in high-need areas of Greater Boston gain training and entry-level employment in healthcare as HHAs.Through its collaborations with other groups (e.g., Mothers for Justice & Equality, HomeCare Aide Council, Mass HomeCare Alliance), CCHERS identified that lack of affordable, accessible, reliable transportation was among the most-cited barriers affecting HHAs and equitable homecare delivery.Corporate partner Uber Health, through work in preliminary social-impact case studies, identified the platform's central ride-coordination approach as preferred by Black and Hispanic women in the 18-45y age group (~80% of the local HHA workforce).MGH researchers' study goals and metrics were informed by input of partners.With its community-engaged approach, innovative partnerships, and focus on achieving equity objectives to benefit patients and homecare workers alike, this project has potential for strong local impacts and future implications for state and/or national policies to provide high-quality, equitable homecare by directly addressing employment transportationrelated barriers.

BRIDGING RESEARCH TO PRACTICE: PRO-HOME EMPOWERS CARE PARTNERS TO PROMOTE EXERCISE IN HOME CARE Chair: Naoko Muramatsu
Regular physical activity (PA) benefits people of all ages.Mounting scientific evidence shows PA's health benefits in older persons with chronic conditions.However, there remains a large research-to-practice gap in PA, especially in long-term services and supports (LTSS).Older adults who need help with basic daily activities, such as walking or standing, continue to face barriers at multiple levels of LTSS to become and remain physically active.This symposium will address the much-debated research-to-practice gaps, focusing on frail community-dwelling older adults in the context of a NIA-funded clinical trial."Promoting Seniors' Health with Home Care Aides (Pro-Home)" tests the effectiveness of a gentle, low-intensity PA program delivered by home care aides (HCAs) for community-dwelling older adults with nursing-home eligible care needs in real-world home care settings.Pro-Home is innovative because it empowers direct care workers (HCAs) with an easy-to-learn toolkit to deliver the program and keep their older clients motivated.The symposium starts with an overview of Pro-Home (Muramatsu), barriers and facilitators of Pro-Home at multiple levels of the LTSS system (Cruz Madrid), followed by Pro-Home's critical elements: of research and practice: client-HCA dyad relationships and partnerships with stakeholders (Hu), in-home assessment of motor function in frail older adults (Yin), and